Chronic conditions have become the leading cause of illness, disability, and death in the United States, affect almost half of the U.S. population, and account for the majority of health care expenditures in this country. Despite efforts to enhance the quality of care delivered to chronically ill patients, studies continue to reveal tremendous variability in both practice and outcomes in this population. This study proposes to bring together a unique collaboration of physicians, employers, health plans, and payers from the private and public sector both regionally and nationally, to achieve a 'tipping point' in health care and, thereby, accelerate the rate at which improvement in the quality of care delivered in outpatients settings for a substantial portion of the chronically itt patient population in the U.S can occur. Specifically, the American Medical Association, Pittsburgh Regional Healthcare Initiative, Iowa Foundation for Medical Care, Blue Cross and Blue Shield Association, Centers for Medicare and Medicaid Services, and the Midwest Business Group on Health are cooperating in a partnership to identify the infrastructure necessary to make relevant data and clinical performance measurement tools available to physicians at the point of care for patients with diabetes, major depressive disorder, or coronary artery disease; to enable data collection, retrieval, and transfer within and across physician offices, health plans, and laboratories; to identify the perceived obstacles, burdens, as well as incentives for physicians and others who participate in efforts to improve the quality of care for patients with chronic diseases through the use of performance measurement; and to determine the feasibility of creating an integrated data registry that will enable the provision of benchmarking data to physicians and aggregate data to health plans and third party payors. The methods by which these aims will be achieved inctude adaptation and implementation of performance measurement sets developed by the Physician Consortium for Performance improvement for diabetes, major depressive disorder, and coronary artery disease in a select sample of primary care physician offices in two regions of the U.S.; on-site identification of data capabilities for physicians, health plans, and laboratories participating in the study; and evaluation of physician, plan, laboratory, and employer experience with measurement tools and data collection and delivery processes.